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  • Journal of Neurosurgery: Spine x
  • By Author: Bekelis, Kimon x
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Symeon Missios and Kimon Bekelis


The accuracy of public reporting in health care is an issue of debate. The authors investigated the association of patient satisfaction measures from a public reporting platform with objective outcomes for patients undergoing spine surgery.


The authors performed a cohort study involving patients undergoing elective spine surgery from 2009 to 2013 who were registered in the New York Statewide Planning and Research Cooperative System database. This cohort was merged with publicly available data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. A mixed-effects regression analysis, controlling for clustering at the hospital level, was used to investigate the association of patient satisfaction metrics with outcomes.


During the study period, 160,235 patients underwent spine surgery. Using a mixed-effects multivariable regression analysis, the authors demonstrated that undergoing elective spine surgery in hospitals with a higher percentage of patient-assigned high satisfaction scores was not associated with a decreased rate of discharge to rehabilitation (OR 0.77, 95% CI 0.57–1.06), mortality (OR 0.96, 95% CI 0.90–1.01), or hospitalization charges (β 0.04, 95% CI −0.16 to 0.23). However, it was associated with decreased length of stay (LOS; β −0.19, 95% CI −0.33 to −0.05). Similar associations were identified for hospitals with a higher percentage of patients who claimed they would recommend these institutions to others.


Merging a comprehensive all-payer cohort of spine surgery patients in New York state with data from the CMS Hospital Compare website, the authors were not able to demonstrate an association of improved performance in patient satisfaction measures with decreased mortality, rate of discharge to rehabilitation, and hospitalization charges. Increased patient satisfaction was associated with decreased LOS.

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Atman Desai, Kimon Bekelis and Kadir Erkmen

Effective surgical obliteration of spinal dural arteriovenous fistulas (DAVFs) traditionally requires laminectomy or hemilaminectomy to allow intradural exposure and occlusion of the draining vein. The authors present successful treatment of a spinal DAVF by using a tubular retractor system to provide minimally invasive exposure at the L5–S1 level adequate for both microsurgical treatment and intraoperative indocyanine green angiography.

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Harold A. Wilkinson

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Atman Desai, Perry A. Ball, Kimon Bekelis, Jon D. Lurie, Sohail K. Mirza, Tor D. Tosteson and James N. Weinstein


Incidental durotomy is an infrequent but well-recognized complication during lumbar disc surgery. The effect of a durotomy on long-term outcomes is, however, controversial. The authors sought to examine whether the occurrence of durotomy during surgery impacts long-term clinical outcome.


Spine Patient Outcomes Research Trial (SPORT) participants who had a confirmed diagnosis of intervertebral disc herniation and were undergoing standard first-time open discectomy were followed up at 6 weeks and at 3, 6, and 12 months after surgery and annually thereafter at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database were reviewed. As of May 2009, the mean (± SD) duration of follow-up among all of the intervertebral disc herniation patients whose data were analyzed was 41.5 ± 14.5 months (41.4 months in those with no durotomy vs 40.2 months in those with durotomy, p < 0.68). The median duration of follow-up among all of these patients was 47 months (range 1–95 months).


A total of 799 patients underwent first-time lumbar discectomy. There was an incidental durotomy in 25 (3.1%) of these cases. There were no significant differences between the durotomy and no-durotomy groups with respect to age, sex, race, body mass index, herniation level or type, or the prevalence of smoking, diabetes, or hypertension. When outcome differences between the groups were analyzed, the durotomy group was found to have significantly increased operative duration, operative blood loss, and length of inpatient stay. However, there were no significant differences in incidence rates for nerve root injury, postoperative mortality, additional surgeries, or SF-36 scores for Bodily Pain or Physical Function, or Oswestry Disability Index scores at 1, 2, 3, or 4 years.


Incidental durotomy during first-time lumbar discectomy does not appear to impact long-term outcome in affected patients.